Morbidity and mortality

MISSING IMAGE

Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00200

Related Items

Preceded by:
Weekly mortality index
Preceded by:
Weekly morbidity report
Succeeded by:
Morbidity and mortality weekly report

Full Text


NATIONAL COMMUNICABLE DISEASE CENTER
NATIONAL COMMUNICABLE DISEASE CENTER


IV


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND W

HEALTH SERVICES AND MENTAL HEALTH ADMINII


EPIDEMIOLOGIC NOTES AND REPORTS
INFLUENZA United States

Between August 27 and September 12, 1968, at least
31 members of a 240-man squadron at Wheeler Air Force
Base, Hawaii, were affected with an influenza-like ill-
ness. Twenty-three squadron members took a week-long
trip to the Philippines, Taiwan, and Japan; the first seven
illnesses began while the men were away or just after the
trip. Most of the 31 men who were ill were confined to
quarters for 2 or 3 days, but none were hospitalized. A2
influenza viruses similar to the Hong Kong strains were
isolated from six specimens taken during this outbreak.
Physicians at Hickam AFB Dispensary, near Hbnolulu,
also report having seen an unusually large number of


Vol. 17, No. 39







,ek Ending

mber 28, 1968


Ei J1 .r. 1: Notes and Reports
.. : United States .. . 357
Diphtheria Madison County, Florida, and Brooks
and Thomas Counties, Georgiaa ............... ..35
Hepatitis Outbreak West Branch, Ogemaw County,
Michigan. ..................... ... 359
Measles Control Ibadan, Western Nigeria ... 362
Relapsing Fever Bend, Oregon . . 362
Surveillance Summary
Salmonellosis April, May, and June 1968 .... 360
Current Trends
Measles United States .................. .. 361
Summary of Reported Cases of Infectious Syphilis .. 363
Recommendation of the Public Health Service Advisory
Committee on Immunization Practices
A2 Influenza Virus Vaccine, Monovalent, 1968-69 368
Influenza Chemophylaxis, 1968-69 . ... 368

influenza-like illnesses in personnel returning from the
Far East. There has been no evidence of illness in the
civilian personnel on the base or in the nearby community.
(Continued on page 358)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
39th WEEK ENDED MEDIAN CUMULATIVE, FIRST 39 WEEKS
MEDIAN
DISEASE September 28, September 30. 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ........ ... ......... 237 94 94 3,108 2,128 1,513
Brucellosis ............................ 11 3 3 169 191 196
Diphtheria............................... 7 7 2 147 97 144
Encephalitis, primary:
Arthropod-borne & unspecified ......... 51 40 980 1.218 -
Encephalitis, post-infectious ............. .5 10 386 661
Hepatitis, serum ......................... ..124 47 6 3,278 1.624 29,
736 29,026
Hepatitis, infectious .................... 1,005 960 33,319 28,704
Malaria ................................ 34 56 4 1,685 1,490 76
Measles rubeolaa) ....................... 120 172 628 19,928 58.,221 241,475
Meningococcal infections, total ........... 24 26 31 2,084 1,729 2,112
Civilian .............................. 23 25 --- 1,903 1,614
Military ............................... .1 1 181 115
Mumps ................................. 744 --- 126,405 ----
Poliomyelitis, total ..................... 5 1 1 47 27 72
Paralytic ............................. 5 1 1 47 23 67
Rubella (German measles) ............... 229 195 --- 44,354 40,217
Streptococcal sore throat & scarlet fever.... 6.112 6,060 5.082 317,086 340,232 304,546
Tetanus ............................... 8 6 6 125 169 198
Tularemia .............................. 5 4 4 149 138 192
Typhoid fever .......................... 11 9 9 287 316 316
Typhus, tick-borne (Rky. Mt. spotted fever) 9 3 6 256 279 215
Rabies in animals ....................... 61 57 57 2.659 3,359 3,359

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
A nthrax: ............................................ 3 R babies in m an: ..................................... -
Botulism: ........................................... 4 Rubella, Congenital Syndrome: .................. ........ 5
Leptospirosis: Okla.-l ............................... 31 Trichinosis:* Iowa.-l, Mich.-1 ......................... 50
P league: ........................ .................. 2 T yphus, m urine: ..................................... 23
P sittacosis: ....................................... 35
*Delayed reports: Trichinosis: Mich.-l







Morbidity and Mortality Weekly Report


SEPTEMBER 28, 1968


INFLUENZA (Continued from front page)


In the first week of September 1968, an outbreak in-
volved 22 of 49 students at the Marine Corps Drill Instruc-
tors School in San Diego, California. The typical syndrome
consisted of dry cough, temperature of 98.6-100F. (only
two or three persons had temperature higher than 100F.),
myalgia. and headache. Several persons complained of
photophobia. Individual illnesses lasted approximately 36
hours, and the entire outbreak occurred over a 4-day period.
Nine contacts in four families also had upper respiratory
infections.
The outbreak was investigated by Preventive Medicine
Unit Number 5 (PMU-' i and Naval Medical Research Unit
Number 4 (NAMRU-4) has isolated viruses similar to the
Hong Kong strains from 9 of 21 throat gargle specimens.
The results of paired sera are pending. No contact between
the ill individuals and persons recently in Southeast Asia
has been established.
In addition to the two reported cases in Atlanta (MMWR,
Vol. 17, No. 36), laboratory confirmed cases have been
reported in Cleveland, Ohio, and Princeton, New Jersey.
Several cases have occurred in State Department employees
returning to Washington, D.C., from the Far East. Investi-
gation of possible secondary spread is underway. A2 viruses
have been isolated in New Jersey and the District of
Columbia.


Several Americans who attended the recent 8th Inter-
national Congresses of Tropical Medicine and Malaria in
Teheran have reported the occurrence of influenza-like
illness during these meetings; influenza may have been
brought by persons attending from Far East areas. Paired
acute and convalescent serum specimens from one individual
show a four-fold rise when tested against the A2/Hong
Kong/68 antigen by hemagglutination-inhibition. Four A2
isolates have been obtained, of which two have already
been shown to be similar to the Hong Kong strains.
(Reported by Robert Penington, Jr., M.D., Chief, Epi-
demiology Branch, Communicable Disease Division, Hawaii
Department of Health; Capt. Eugene ,. MC USN, Capt.
Thomas M. Floyd, MSC USN, Lt. Comdr. RichardNail, MC
USN, PMU-5, San Diego, California; Capt. Robert P. Peck-
inpaugh, MC USN; Max Rosenbaum, Ph.D., Lt. Comdr.
Patricia DeBerry, MSC USN, and Miss Elizabeth .?.:. ,.
NAMRU-4, Great Lakes, Illinois; Ronald Altman, M.D.,
.-. "', Director, Division of Preventable Diseases, New
Jersey State Department of Health; John R. Pate, M.D.,
Chief of Communicable Disease Control, District of Colum-
bia Department of Public Health; Robert M. Chanock, M.D.,
NIAID, Carleton D. Gajdusek, M.D., \\Ilh. and J. Anthony
Morris, Ph.D., DBS, National Institutes of Health, R. ir ,d, .
Maryland; and EIS Officers.)


DIPHTHERIA Madison County, Florida, and Brooks and Thomas Counties, Georgia


On August 26, 1968, a 7-year-old girl, a resident of
Cherry Lake, Madison County, Florida, developed a sore
throat and was treated symptomatically after routine throat
culture reports were negative. She worsened clinically,
was hospitalized in nearby Quitman, Brooks County, Geor-
gia, on September 1, and died on September 2 with pre-
sumptive diphtheria. Within 3 days, three younger brothers
2-, 4-, and 5-years-old were hospitalized with clinical
illness; two had throat cultures positive for Coryne bacterium
diphtheriae. The 5-year-old died on September 10. Each
received more than 100,000 units of diphtheria antitoxin in
addition to antibiotic therapy. Throat swabs were taken on
four of the remaining five family members. One, from an
11-year-old boy, was positive for C. diphtheriae. Isolates
obtained by the Georgia Department of Public Health Lab-
oratories were "mitis-like" toxigenic C. diphtheriae.
The family lives in rural Madison County and their
activities are limited to the farm, school, and country store.
They use commercial pasteurized milk. The children in the
family had not been immunized against diphtheria.
Because the immunization status of the populace was
unknown. a mass immunization program was undertaken by
the county and state health departments September 8-14;
clinics were held at strategic locations within the county.
Jet injectors were used to administer 0.5 ml doses of tetanus
and diphtheria toxoids, adult type, to 55.7 percent of the
total county population (Table 1). This included 73 per-
cent of the estimated county population under 14 years of


Table 1
Number of People Given Initial Dose of Tetanus and
Diphtheria Vaccine in Public Health Clinics
Madison County, Florida, September 8-14, 1968

Population Number Vaccinated
Age (Years) Estimate Vaccinated Percent

Less than 1 238 123 51.7
1-4 994 691 69.5
5-14 3,206 2,422 75.5
15 and over 11.1..6-* 5,125 48.5
Total 15,000 8,361 55.7
Figures derived by Florida State Board of Health, Division of
Public Health Statistics, employing 1967 population estimates,
annual birth rates, and school enrollment figures.

age. The number vaccinated by private physicians is un-
known. The second 0.5 ml dose of vaccine will be given
early in October.
Subsequent to the outbreak of diphtheria in Madison
County, Florida, two cases occurred in the week of Septem-
ber 23 in Thomas County. Georgia, which is adjacent to
Brooks County and to Florida. The first patient, an 8-year-
old girl who had been immunized in infancy, had a throat
culture positive for toxigenic "mitis-like" C. diphtheria.
She recovered with antibiotic therapy. The second patient,
an unimmunized 3-year-old boy, died despite massive doses
of antitoxin.


358






Morbidity and Mortali


The Brooks County Health Department has given 2,000
doses of tetanus and diphtheria toxoid and has made the
vaccine available to all residents of the county. Thomas
County officials have given 3,400 doses of the vaccine and
plan to give several thousand more in the first week of
October.
(Reported by L. Brendle, M.D., County Health Officer,
Madison County, Florida; C. L. Mayfield, M.D., M.P.H.,


SEPTEMBER 28, 1968


HEPATITIS OUTBREAK West Branch, Ogemaw County, Michigan


Between April 1 and May 26, 1968, an outbreak of
infectious hepatitis due to contaminated bakery goods
occurred in Michigan (Figure 1). Of 63 cases reported in
Ogemaw County, 61 had onset of illness between April 28
and May 26. None of the 61 patients under 5 years old
(Table 2); 6.6 percent were 5-9 years old; 67.2 percent
were 10-19 years old; and 26.2 percent were 20 years or
older. The attack rate for males, 8.1 cases per 1,000 popu-
lation, was nearly twice that for females, 4.5 cases per
1,000 population.

Figure I
INFECTIOUS HEPATITIS OGEMAW COUNTY, MICHIGAN
APRIL-MAY 1968
DATE OF ONSET FOR 63 CASES
12 LtVING IN OGEMAW COUNTY


- 71


4 6 810i 12 14 16 18 20 22 24 2z28301 2 4'6 8 10 12 14 i 4s ( i216 4 2 2 'iol
APRIL MAY

DATE OF ONSET FOR 13 CASES
4 LIVING OUTSIDE OGEMAW COUNTY



2 4 6 '10 12 14 16 18 20 22 24 2 286 28 4 6 8 10 14 16 18 22 24 26 28 2 ol
APRIL MAY
2 --AY INTERVAL
ADJACENT COUNTY RESIDENT
I OISTANT CASE

The clustering of cases in a short time period and in
a single age group suggested a common source of expo-
sure. Water and milk did not appear to be responsible;
however, a series of associations implicated baked goods
from bakery in West Branch. A.th,-.il.h most of the patients
in Ogemaw County gave a history of having eaten food from
this bakery, it was impossible on the basis of these inter-
views alone to know whether the bakery was the source of
the epidemic or simply a popular place. However, interviews
with ill persons from adjacent counties and distant areas
revealed that although they had infrequent contact with
most establishments in Ogemaw County, they consistently
had had some contact with the bakery. The probable time
of exposure could be narrowed to within the first two weeks
of April.


Table 2
Infectious Hepatitis Ogemaw County
April 28-May 26
Attack Rates by Age and Sex
Attack Rate
Age Number of Cases per 1,000 Population*
Group
Male Female Total Male Female Total

0-4 0 0 0 0.0 0.0 0.0
5-9 2 2 4 3.7 4.5 4.0
10-14 12 6 18 22.2 13.4 18.2
15-19 16 7 23 35.9 16.6 26.5
20-24 1 3 4 4.2 11.8 8.1
25-29 0 1 1 0.0 4.6 2.2
30-34 3 0 3 14.1 0.0 6.9
35-39 1 2 3 4.0 6.7 5.5
40-44 2 0 2 7.4 0.0 3.7
45-49 1 0 1 3.4 0.0 1.7
50-54 2 0 2 7.6 0.0 3.8
55+ 0 0 0 0.0 0.0 0.0

Total 40 21 61 8.1 4.5 6.3
*Based on 1960 Census


Further evidence supporting baked goods as the ve-
hicle was that oneof the two Ogemaw County cases wasin
a baker's assistant at the bakery. The man saw a physi-
cian on April 6 but worked until April 11, when the diag-
nosis of infectious hepatitis was made. He did not return
to work until April 23, 1968.
At the bakery it was observed that icing was spread
on pastry by hand, and glazed items were dipped in the
glaze by hand. In contrast, even though dough is shaped
by hand into bread and rolls, these are then baked in a
3500-4000F. oven for 15-45 minutes. Since pastry is not
cooked further after hand glazing or icing, these processes
are likely points of contamination. Both glaze and icing
may be kept for several days and old batches used to
start new ones. Bakery products not sold on one day may
be sold on the next business day as day-old pastry or
frozen for sale in the next 1-2 weeks. Therefore contami-
nated goods could have been available for consumption
over a period of several days or weeks.
Two surveys were conducted during the investigation.
In the first, an investigator estimated the age of each
bakery patron, hour of sale, kind of products purchased.
and amount purchased. The age distribution of the bakery
(Continued on page 360)


ity Weekly Report 359


Director, Bureau of Preeentable Diseases, Florida Stair
Board of Health; E. C. Prather, M.D., M.P.H., Associate
Director, Bureau of Preventable Diseases. Florida State
Board of Health; J. E. McCroan, Ph.D., State Epidemi-
ologist, GeorgiaDepartment of Public Health; Tuberculos is
and Parasitology Laboratory, Georgia Department of Public
Health; and an EIS Officer).


2*






Morbidity and Mortality Weekly Report


SEPTEMBER 28, 1968


HEPATITIS (Continued from page 359)


patrons for the day of observation closely resembled the
age distribution of reported cases (Figure 2).

Figure 2
FREQUENCY POLYGON SHOWING PERCENT DISTRIBUTION
BY AGE OF PATRONS OF WEST BRANCH BAKERY
vs. PERCENT DISTRIBUTION BY AGE OF CASES
OF INFECTIOUS HEPATITIS IN OGEMAW COUNTY,
o MICHIGAN

~A BK y PATRONS aS MEASURED BY HEAD COUNT


so /
N/ \N 3 96


F o
40 f \





5 'o IS 20 25 30 3`5 40 15 50 55 6o 65 o0 Is ED
AGE IN YEARS ASSUME MAXIMUM AGE OF 901

In the second survey, questionnaires were used to
obtain comparable histories of exposure to possible com-
mon vehicles. Interviews were completed for all 61 Oge-
maw County patients with onset of illness between April 28


and May 25. In addition, all persons 10-19 years old in the
household of each patient were interviewed. Ninety-two
percent of the 41 patients 10-19 years old ate -omrn-hing
from the bakery between April 1 and April 14, 1968; only
47 percent of the 56 household members had eaten bakery
goods. Contact with municipal water was high among pa-
tients (88 percent) but was slightly higher among house-
hold members (92 percent).
The high attack rate in high school students appeared
to be due to the fact that many pupils at the public high
school go regularly to the bakery and buy pastry for lunch.
The sex distribution of the cases of hepatitis in Ogemaw
County remains unexplained.
During the epidemic, gamma globulin was offered to
all residents of the city and the immediately surrounding
area and to all school and household contacts. No cases
of hepatitis with date of onset after May rit. 1968, have
been reported in Ogemaw County.
(Reported by Ophelia Baker, M.D., Health .,'.', ir Michi-
gan District Number 2 Health Department; George Agate,
M.D., State Epidemiologist, Michigan State Department
of Health; Zdenek Jezek, M.D., Senior Medical Ofl. *',
WHO; and three EIS Officers.)


SURVEILLANCE SUMMARY
SALMONELLOSIS April, May, and June 1968

In April, May, and June 1968, the total numbers of Figure 3
salmonella isolations from humans were 1,194, 1,794, and REPORTED HUMAN ISOLATIONS OF SALMONELLAE
S.,IN THE UNITED STATES
1,556, respectively, and the weekly averages for the 3
months were 298, 359, and 389. respectively (Figure 3).
Table 3 lists the 10 most frequently reported serotypes
from human sources and nonhuman sources. For the same 3 /
months, 884, 853, and 777 nonhuman isolations were reported.
During the month of June, there was a marked increase
in the number of isolations and in the number of states re-
porting Salmonella javiana. From January to May, the
average number of isolations of S. Javiana was fewer than
4 per week; the number of states reporting isolations, fewer ..: .: ..
Table 3
Summary of 10 Most Frequently Reported Serotypes from Humans and Nonhumans
April, May, and June 1968

Human Nonhuman
Serotype Number Percent Serotype Number Percent
typhi-murium* 1,364 30.0 typhi-murium* 385 15.3
enterilidis 385 8.5 heidelberg 162 6.4
heidelberg 310 6.8 infants 149 5.9
newport 249 5.5 anatum 146 5.8
saint-paul 235 5.2 montevideo 137 5.4
infantis 182 4.0 saint-paul 122 4.9
blockley 137 3.0 cubana 104 4.1
typhi 127 2.8 derby 91 3.6
thompson 117 2.6 thompson 87 3.5
.' -. 9n ". 82 3.3
Subtotal 3,196 70.3 Subtotal 1,465 58.3
Total all serotypes 4,544 Total all serotypes 2,514
"Includes var. copenhagen 77 1.7 68 2.7


360









than 6 per month. In June, the average number of isola-
tions increased to 15.8 per week (see Table 4), and the
number of states reporting isolations jumped to 19. No
similar increase occurred during the comparable period in
Table 4
Isolations of Salmonella javiana, 1968
Month Total Isolations Average No./Week
January 21 4.2
February 14 3.5
March 3 0.8
April 4 1.0
May 22 4.4
June 63 15.8


361


1967. Although a large part of the increased number of
isolations can be accounted for by the outbreak of 26 cases
in California in June (see Salmonella Surveillance Report
No. 74), the wider distribution remains unexplained.
(Reported by Salmonellosis Unit, Bacterial Diseases Sec-
tion, Epidemiology Program, NCDC.)

A copy of the original reports from which these data were
derived is available on request from:
National Communicable Disease Center
Atlanta, Georgia 30333
Attn: Chief, Salmonellosis Unit
Bacterial Diseases Section
Epidemiology Program


CURRENT TRENDS


MEASLES -
From July 14 through August 10 (weeks 29-32), 1968,
measles was reported from 208 counties or health districts,
whereas 291 counties or health districts reported measles
during the comparable 4-week period in 1967. Of these 208
areas, 17 (8.2 percent) reported a total of 10 or more cases
(Figure 4); last year in the same period 28 of 291 (9.6 per-
cent) reported 10 or more cases (Figure 5).
During the 4-week period, August 11 through Septem-
ber 7 (weeks 33-36), 1968, measles was reported from 159
counties or health districts; 209 counties reported cases
in that 4-week period in 1967. Of these 159 counties, 11


United States
4-week period in 1967 (Figure 7). In addition, the percentage
of counties or health districts reporting only one case of
meas-les for weeks 33-36 of 1968 increased to 53 percent
from the 41 percent for those weeks in 1967.
It is noteworthy that of the 11 counties reporting a
total of 10 or more cases in weeks 33-36 in 1968, 82 per-
cent were major metropolitan areas with more than 100,000
population. In 1967, 57 percent of the counties reporting a
similar numberofcases forthe corresponding 4-week period
were major metropolitan areas.


(6.9 percent) reported 10 or more cases (Figure 6), com- (Reported by State Services Section and Statistics Section,
pared with 14 of 209 (6.7 percent) in the corresponding Epidemiology Program, NCDC.)
Figure 4 Figure 6
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES OF 10 OR MORE CASES OF MEASLES
JULY 14 THROUGH AUGUST 10, 1968 AUGUST 11 THROUGH SEPTEMBER 7, 1968

Q~( *
/~~~~~~~~ V.--4 v'. T A- L -"34 -AT


Figure 5
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
JULY 16 THROUGH AUGUST 12, 1967
'S,


Figure 7
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
UGUST 13 THROUGH SEPTEMBER 9, 1967

r / ~~ ~ -r^ -r^ f


SEPTEMBER 28, 1968


Morbidity and Mortality Weekly Report


I






362


Since September 1967, the monthly measles incidence
in Ibadan, Western ,.r.,. (population 843,000) has re-
mained at levels approximately one-tenth as high as pre-
viously reported. As shown in Figure 8, 1,597 cases of
measles were reported for January-June 1967. As is char-
acteristic in urban Africa, most of the cases were in chil-
dren under 3 years old. During a 10-day period in July
1967, a mass smallpox and measles immunization campaign
was conducted in Ibadan in which 72,359 measles immuni-
zations were given. A survey showed that 92.2 percent of
the children 0-4 years old were vaccinated. Measles in-
cidence abruptly declined in August, and only 131 cases
reported during the period August-December 1967.

Figure 8
REPORTED MEASLES CASES
IBADAN, NIGERIA
JANUARY 1967 JULY 1968


However, approximately 6 months after the campaign,
an increase in measles cases was noted. This increase,
coinciding with the previously characteristic pattern of a
rise in reported cases in the dry season, resulted from an


SEPTEMBER 28, 1968


accumulation of susceptible children entering the popula-
tion after the mass campaign. Health authorities conducted
a second mass measles and smallpox immunization cam-
paign in February 1968. This time, the target group was
children 6 months to one year of age, i.e., the susceptibles
born since the previous campaign. The increase in inci-
dence was abruptly terminated, and the number of reported
cases declined again to low levels.
In July 1968, measles incidence again began to climb,
so a second measles control "maintenance" immunization
campaign was carried out. Again the measles incidence
declined.
(Reported by the Smallpox Eradication Program, NCDC.)
Editorial Note:
These observations support the concept that mass
measles immunizations can dramatically reduce the inci-
dence of measles cases in Africa, and that measles con-
trol can be maintained. However, a mass campaign alone
does not assure effective disease control for more than a
very brief period, as measles-susceptible children are
constantly entering the population. To maintain measles
control in urban areas in Africa, mass vaccination programs
are necessary at intervals of not more than 6 months. In
Ibadan 20,000 to 25,000 babies, all susceptible to mea-
sles, are born every six months; this population is more
than enough to support a major measles epidemic. That the
expected dry-season rise in 1968 was halted by mainten-
ance immunizations in February 1968, further affirms the
efficacy of periodic mass measles immunization, used
either as a "maintenance" or a 'fir-fgihilng" technique,
in sustaining effective control of the disease.


RELAPSING FEVER Bend, Oregon


In Bend, Oregon, a 68-year-old woman, hospitalized
with relapsing fever, died on August 29, 1968. In late July
prior to her illness, she had gone fishing with her husband
and had been "bitten up by chiggers." Several days later
she had abrupt onset of chills, fever, fatigue, dyspnea,
orthopnea, dry cough, mild left anterior pleuritic chest
pain, and pedal edema. She gave no history of heart disease.
When she was admitted to the hospital on August 19,
the initial diagnostic impression was of congestive heart
failure, secondary to viral or bacterial myocarditis. Physical
findings were temperature 102*F., blood pressure iJ4 '.1,
and pulse rate 108. Cardiac examination was normal; moist
rales were heard over the lower posterior one-third of both
lung fields; the liver was tender below the right costal
margin: and there were no petechiae. Trace pedal edema
and marked plamar erythema were present, and the proximal
digit of the right index finger was tender and red. On August
20 she received both penicillin and kanamycin I.M., and 18
hours later she was afebrile. She gradually lost conscious-
ness. however, and had frequent cardiac arrhythmias, in-
cluding a rapid tachycardia with a rate of 400, which was
terminated by intravenous lidocain. On August 23 she de-


veloped sudden onset of an arrhythmia and could not be
resuscitated with closed cardiac massage.
Early in her illness a spirochetal organism was found
on a blood smear, suggesting leptospirosis or relapsing
fever in the differential diagnosis. Six blood cultures ob-
tained on August 19 and 20 grew Borrelia recurrentis. The
Oregon Public Health Laboratory confirmed the organisms
as B. recurrentis on the basis of size and staining pro-
perties with aniline dye. The agglutination test was nega-
tive for leptospires.
Investigators found no logs, wood piles, or evidence
of rodents at the woman's home. No ticks were found on
the family dog that had accompanied the couple on the
fishing trip or on the river bank where they had fished.

(Reported by Raymond Graap, M.D., Bend, Oregon; A.B.
Kind, M.D., Health Officer, Deschutes County Health De-
partment; Robert A. Gresbrink, M.P.H., Program Supervisor,
Vector Control Program, M.A. Holmes, D.V.M., M.P.H.,
Public Health Veterinarian, and Gatlin R. Brandon, M.P.H.,
Director, Section of Public Health Laboratory, Oregon State
Board of Health; and an EIS Officer.)


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
MEASLES CONTROL Ibadan, Western Nigeria


MAss VACCINATiON


MAINTENANCE VACCINATION








SEPTEMBER 28, 1968 Morbidity and Mortality Weekly Report




SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas July 1968 and 1967--Provisional Data

Cumulative Cumulative
Reporting Area July Jan July Reporting Area July Jan July
1968 1967 1968 1967 1968 1967 1968 1967
NEW ENGLAND............... 23 22 189 203 EAST SOUTH CENTRAL....... 124 132 865 1,049
Maine.................... 2 2 4 2 Kentucky................ 6 13 64 88
New Hampshire.....1...... 5 Tennessee................ 27 36 211 166
Vermont .................. 2 Alabama................. 72 50 382 561
Massachusetts.... ..... 16 8 115 120 Mississippi............. 19 33 208 234
Rhode Island............ 2 5 23 22
Connecticut............ 3 7 46 52 WEST SOUTH CENTRAL....... 344 289 2,049 1,845
Arkansas................ 13 9 80 76
MIDDLE ATLANTIC.......... 278 256 1,840 2,013 Louisiana............ 100 48 519 357
Upstate New York..... 32 24 134 163 Oklahoma............. 7 9 50 75
New York City........... 175 142 1,176 1,177 Texas............. ... 224 223 1,400 1,337
Pa. (Excl. Phila.)...... 18 13 126 136
Philadelphia............ 21 32 142 182 MOUNTAIN................. 33 52 297 358
New Jersey.............. 32 45 262 355 Montana.................. 2 6 4
Idaho. ................... 3 3 17
EAST NORTH CENTRAL........ 216 240 1,672 1,817 Wyoming............. 1 13
Ohio.................... 42 57 275 371 Colorado ............... 5 9 43
Indiana.............. 20 13 196 75 New Mexico.............. 13 14 88 96
Downstate Illinois....... 18 8 103 96 Arizona................ 11 27 153 171
Chicago................. 86 56 599 529 Utah..................... 1 8 5
Michigan................. 50 106 487 730 Nevada............... 6 1 29 9
Wisconsin.............. 12 16
PACIFIC............. ..... 156 138 1.000 1,073
WEST NORTH CENTRAL...... 41 29 223 172 Washington............... 7 6 32 35
Minnesota................ 9 6 27 26 Oregon................... 4 5 23 31
Iowa ................... 2 6 21 20 California............... 143 126 940 1.000
Missouri................ 25 8 112 56 Alaska................... 1 1 1 2
North Dakota......... 6 2 Hawaii................ 1 4 5
South Dakota............. 2 2 25 20
Nebraska................ 2 2 19 18 S. TOTAL............... 1,598 1,732 11,149 12.191
Kansas................... 1 5 13 30
TERRITORIES............. 81 55 664 436
SOUTH ATLANTIC............ 383 574 3,014 3,661 Puerto Rico............ 81 51 633 411
Delaware................ 3 1 21 30 Virgin Islands........... 4 31 25
Maryland................ 59 53 281 368
District of Columbia..... 39 87 363 441
Virginia................. 25 29 168 173
West Virginia............ 3 1 22 11
North Carolina........... 34 80 377 437 Note: Cumulative Totals include revised and delayed reports
South Carolina.......... 41 70 304 501 through previous months.
Georgia................. 74 90 474 553
Florida.................. 105 163 1,004 1,147








CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas August 1968 and August 1967 Provisional data

Cumulative Cumulative
Reporting Area August Jan-Aug Reporting Area August Jan-Aug
1968 1967 1968 1967 1968 1967 1968 1967
NEW ENGLAND.............. 35 36 222 239 EAST SOUTH CENTRAL........ 102 158 970 1,207
Maine.................. 1 5 2 Kentucky................. 14 23 79 111
New Hampshire........... 2 7 Tennessee................ 13 19 224 185
Vermont................. 2 Alabama.................. 38 81 420 642
Massachusetts........... 221 1 136 141 Mississippi............. 37 35 247 269
Rhode Island..:......... 1 23 23
Connecticut............. 13 12 58 64 WEST SOUTH CENTRAL........ 287 238 2,334 2,083
Arkansas.............. 7 8 87 84
MIDDLE ATLANTIC..... .. 327 399 2.136 2,412 Louisiana................ 67 48 585 405
Upstate New York........ 42 33 175 196 Oklahoma.............. 6 7 55 82
New York City........... 197 259 1,323 1,436 Texas................. 207 175 1,607 1,512
Pa. (Excl. Phila.)...... 13 16 161 152
Philadelphia..... ..... 27 33 169 215 MOUNTAIN................. 37 51 335 409
New Jersey.............. 48 58 308 413 Montana................ 5 4
Idaho............... 2 17
EAST NORTH CENTRAL....... 217 272 1,892 2,089 Wyoming.................. 1 13
Ohio ................. 24 42 299 413 Colorado................ 3 6 12 49
Indiana................ 35 8 231 83 New Mexico.............. 15 29 103 125
Downstate Illinois...... 19 10 122 106 Arizona.................. 15 12 172 183
Chicago.................. 75 105 677 634 Utah.................. 1 8 6
Michigan................. 59 105 546 835 Nevada. ................ 3 3 32 12
Wisconsin............... 5 2 17 18
PACIFIC.............. .. 176 147 1,165 1,220
WEST NORTH CENTRAL........ 38 43 255 215 Washingon...... ......... 3 3 35 38
Minnesota............ 7 9 34 35 Oregon................. 1 2 24 33
Iowa.................... 5 7 26 27 California............... 171 139 1,100 1,139
Missouri................. 22 7 134 63 Alaska .............. 1 2
North Dakota........... 2 4 4 Hawaii................... 1 3 5 8
South Dakota............ 1 4 26 24
Nebraska................ 1 11 16 29 S. TOTAL............... 1,715 1,950 12,815 14,141
Kansas.................. 2 3 15 33
Ka ................... 2 3 15 33 ERRITORIES....... ..... 117 86 778 522

SOUTH ATLANTIC............ 496 606 3,506 4,267 Puerto Rico.............. 106 86 739 497
Delaware............. 2 15 23 45 Virgin Islands.......... 11 39 25
Maryland............... 41 64 321 432
District of Columbia..... 55 82 418 523
Virginia................. 43 45 211 218
West Virginia............ 6 3 28 14
North Carolina.......... 57 82 433 519 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 45 65 349 566 through previous months.
Georgia................. I11 114 584 667
Florida.................. 136 136 1,139 1,283


363








361 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 28, 1968 AND SEPTEMBER 30, 1967 (39th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS including In tous Serum InfeciousLARIA
Infectious Serum Infectious
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 237 94 11 7 51 40 5 124 1,005 960 34

NEW ENGLAND.......... 4 1 2 3 5 53 33
Maine*............. 1 2
New Hampshire...... 2 2
Vermont............ 1 2 1
Massachusetts...... 1 1 2 1 23 12
Rhode Island ....... 1 1 1 1 17
Connecticut........ 2 1 2 8 16

MIDDLE ATLANTIC...... 99 13 4 2 36 174 149 8
New York City...... 28 7 1 27 63 58
New York, up-State. 8 1 27 29 -
New Jersey.......... 41 5 3 5 23 23 7
Pennsylvania....... 22 1 1 4 61 39 1

EAST NORTH CENTRAL... 47 12 25 18 1 5 133 137 2
Ohio............... 13 3 22 15 1 1 41 35 -
Indiana............ 2 2 15 8 1
Illinois........... 4 5 2 1 1 35 44 -
Michigan........... 29 2 1 3 38 45 1
Wisconsin........... 1 4 5

WEST NORTH CENTRAL... 10 3 2 5 1 1 50 47 2
Minnesota............ 9 2 1 13 18 -
Iowa............... 2 2 1 1 10 5 -
Missouri............... 1 9 15 2
North Dakota....... 1 1 2
South Dakota ......
Nebraska ........... 3 1
Kansas ............. 1 14 6

SOUTH ATLANTIC....... 18 36 8 3 4 10 128 101
Delaware............ 1 5 -
Maryland ........... 4 32 1 1 3 14 21
Dist. of Columbia.. 3 1
Virginia........... 6 8 1 1 20 11
West Virginia ...... 6 2 10 15
North Carolina..... 3 6 -
South Carolina..... 1 7
Georgia ............ 21 30
Florida............ 1 2 2 7 49 12 -

EAST SOUTH CENTRAL... 2 7 1 3 1 3 2 80 100 4
Kentucky ........... 1 36 71 3
Tennessee.......... 1 6 1 1 1 2 24 9 -
Alabama.*.......... 1 3 12 5 -
Mississippi......... 2 8 15 1

WEST SOUTH CENTRAL... 6 1 4 2 4 3 61 127 1
Arkansas ........... 30
Louisiana.......... 3 2 2 2 18 19 1
Oklahoma............ 1 8 14 -
Texas.............. 2 1 4 1 1 35 64 -

MOUNTAIN ........... 1 2 1 1 42 35 1
Montana.............. 2 12 6
Idaho.............. 1
Wyoming ............. -
Colorado........... 12 -
New Mexico......... 1 7 27 1
Arizona............ 8 1
Utah.......... ....... 1 3
Nevada............ -

PACIFIC.............. 50 21 7 5 2 62 284 231 16
Washington......... 1 25 25 1
Oregon.............. 2 1 4 14 20
California......... 46 17 7 4 2 58 241 181 9
Alaska.............. 1 -
Hawaii.............. 1 4 ; ,

Puerto Rico .......... 21 30 1

*Delayed Reports: Diphtheria: Ala. 3
Hepatitis, infectious: Me. 2
Malaria: Me. 1








Morbidity and Mortality Weekly Report 365


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 28, 1968 AND SEPTEMBER 30, 1967 (39th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 120 19,928 58,221 24 2,084 1,729 744 5 5 47 229

NEW ENGLAND.......... 4 1,164 850 121 70 67 1 30
Maine. ........... 37 239 6 3 2 1
New Hampshire...... 141 74 7 2 8 -
Vermont............ 2 34 1 1 3
Massachusetts .*.... 1 365 351 63 33 41 1 8
Rhode Island....... 1 6 62 9 4 3 2
Connecticut........ 2 613 90 35 27 10 19

MIDDLE ATLANTIC...... 27 4,129 2,289 5 376 285 39 10
New York City...... 19 2,149 468 75 51 33 6
New York, Up-State. 5 1,223 590 67 69 NN 4
New Jersey.......... 1 640 490 3 131 94 6 -
PennsylvaniaA ..... 2 117 741 2 103 71 NN -

EAST NORTH CENTRAL... 25 3,836 5,541 5 256 234 173 1 1 3 60
Ohio................ 296 1,150 3 70 80 10 1 1 1 8
Indiana .......... 2 678 597 1 36 25 12 1 6
Illinois........... 5 1,374 997 56 55 11 1 4
Michigan........... 3 275 940 1 74 57 55 22
Wisconsin.......... 15 1,213 1,857 20 17 85 20

WEST NORTH CENTRAL... 385 2,876 2 113 75 60 2 2 4 10
Minnesota.......... 16 134 1 27 19 -
Iowa................. 99 749 7 15 52 2 2 2 6
Missouri........... 81 333 37 15 2 2 1
North Dakota....... 134 870 3 1 5 1
South Dakota........ 4 55 5 6 NN -
Nebraska........... 41 641 1 7 13 1 -
Kansas............. 10 94 27 6 2

SOUTH ATLANTIC....... 10 1,525 6,915 4 416 333 70 3 20
Delaware............ 16 48 8 6 1 1
Maryland........... 2 102 162 34 43 6 -- 2
Dist. of Columbia.. 6 23 14 10 1 1
Virginia........... 3 305 2,192 2 38 40 7 3
West Virginia...... 1 290 1,392 1 12 27 33 1 11
North Carolina..... 282 856 1 78 71 NN 1
South Carolina..... 12 511 56 29 1
Georgia............. 4 36 85 50 -
Florida............. 4 508 1,695 91 57 22 2

EAST SOUTH CENTRAL... 496 5,221 1 188 134 19 2 12
Kentucky............ 100 1,337 1 86 37 5 1 1
Tennessee.......... 62 1,887 54 57 12 11
Alabama............ 94 1,329 26 26 2 1 -
Mississippi........ 240 668 22 14 -

WEST SOUTH CENTRAL... 19 4,846 17,469 2 310 223 60 2 2 23 18
Arkansas........... 2 1,404 20 31 -
Louisiana........... 23 155 89 88 1
Oklahoma............ 123 3,351 50 17 1 2
Texas.............. 19 4,698 12,559 2 151 87 59 2 2 21 17

MOUNTAIN ............ 9 1,006 4,686 2 34 33 66 23
Montana............ 59 289 1 6 2 7 2
Idaho.............. 21 386 11 3 2 3
Wyoming............ 1 52 181 1 1 1 -
Colorado........... 4 508 1,574 10 13 17 10
New Mexico......... 112 591 3 7 -
Arizona............. 4 228 1,020 2 4 25 7
Utah................ 21 376 1 4 8 1
Nevada............. 5 269 3 3 -

PACIFIC.............. 26 2,541 12,374 3 270 342 190 11 46
Washington........... 2 535 5,456 39 31 45 1 5
Oregon.............. 4 529 1,618 21 27 13 13
California......... 20 1,440 4,988 3 196 270 118 10 25
Alaska............... 2 140 2 10 9 2
Hawaii............... 35 172 12 4 5 1

Puerto Rico.......... 6 418 2,129 20 13 14 2

*Delayed Reports: Measles: Mass. delete 2, Pa. delete 12, La. 21, Colo. 3
Poliomyelitis, paralytic: Ind. 1
Rubella: Me. 9







366 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 28, 1968 AND SEPTEMBER 30, 1967 (39th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1968 1968 1968 1968 1968 1968 1968 1968 1968 1968 1968
UNITED STATES... 6,112 8 125 5 149 11 287 9 256 61 2,659

NEW ENGLAND........... 530 1 3 46 8 1 70
Maine........... 6 53
New Hampshire...... 24 1 2
Vermont............ 13 46 11
Massachusetts...... 95 1 4 1 3
Rhode Island....... 27 -
Connecticut........ 365 1 2 3 1

MIDDLE ATLANTIC..... 99 15 7 2 23 1 19 2 42
New York City..... 6 8 1 11 -
New York, Up-State. 71 4 7 1 5 4 2 35
New Jersey......... NN 4 6 -
Pennsylvania....... 22 3 3 1 9 7

EAST NORTH CENTRAL... 375 1 11 2 10 1 37 8 1 250
Ohio................ 42 1 1 1 14 6 86
Indiana............. 92 2 1 3 80
Illinois........... 67 5 2 7 1 19 2 35
Michigan............ 105 2 1 13
Wisconsin.......... 69 1 1 1 36

WEST NORTH CENTRAL... 211 1 11 13 1 32 9 14 647
Minnesota.......... 9 2 7 202
lowa ............... 84 4 1 2 1 3 108
Missouri........... 11 1 3 7 24 3 1 93
North Dakota ....... 68 3 105
South Dakota....... 12 3 1 4 79
Nebraska........... 2 2 3 1 25
Kansas............. 25 3 2 35

SOUTH ATLANTIC....... 699 2 27 1 11 1 55 2 137 14 310
Delaware........... 5 1 1
Maryland............ 47 3 9 2 18 5
Dist. of Columbia.. 2 2 1 1
Virginia............ 248 4 1 3 9 42 3 111
West Virginia...... 203 2 2 4 38
North Carolina..... 4 2 2 2 37 1 12
South Carolina..... 45 3 1 4 9 -
Georgia............. 3 4 14 26 3 56
Florida............. 142 2 11 2 16 3 2 86

EAST SOUTH CENTRAL... 1,174 15 8 31 2 48 12 572
Kentucky*.......... 185 I 1 6 10 4 288
Tennessee.......... 744 6 5 16 2 33 3 256
Alabama............ 106 5 2 3 22
Mississippi........ 139 3 2 7 2 5 6

WEST SOUTH CENTRAL... 641 3 25 1 44 4 40 4 28 4 428
Arkansas.......... 3 4 1 15 4 11 1 6 54
Louisiana.......... 16 9 6 6 1 1 40
Oklahoma............ 20 8 12 1 13 117
Texas.............. 602 3 12 15 11 1 8 4 217

MOUNTAIN............. 1,108 1 8 15 5 4 78
Montana............ 30 -
Idaho.............. 100 -
Wyoming............ 61 1 1 3
Colorado............. 542 3 2 -4 1 4
New Mexico......... 193 8 2 33
Arizona............ 89 -- 3 36
Utah.............. 93 1 4 -
Nevada............ 1 1 2

PACIFIC.............. 1,275 18 2 2 46 1 10 262
Washington......... 500 2 -- 2
Oregon.............. 59 I 5 6
California......... 467 16 1 2 39 1 10 254
Alaska............... 87 -
Hawaii............... 162 -

Puerto Rico.......... 6 1 9 3 17

*Delayed Reports: SST: Me. 3
Tetanus: Iowa 1
Typhus fever, tick-borne: Md. 1
Rabies in animals: Ky. delete 1








Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED SEPTEMBER 28, 1968


367


(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia. Under
Area All 65 years and 1 year Area All 65 years and year
Ages and over Influenza All ver Influenza All
All Ages Causes AAll Ages Causes


NEW ENGLAND:
Boston, Mass.----------
Bridgeport, Conn.-----
Cambridge, Mass.------
Fall River, Mass.-----
Hartford, Conn.-------
Lowell, Mass.----------
Lynn, Mass.----------
New Bedford, Mass.----
New Haven, Conn.------
Providence, R. I.-----
Somerville, Mass.-----
Springfield, Mass.----
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.---------
Allentown, Pa.--------
Buffalo, N. Y.--------
Camden, N. J.---------
Elizabeth, N. J.------
Erie, Pa.-------------
Jersey City, N. J.---
Newark, N. J.---------
New York City, N. Y.--
Paterson, N. J.-------
Philadelphia, Pa.-----
Pittsburgh, Pa.--------
Reading, Pa.----------
Rochester, N. Y.------
Schenectady, N. Y.----
Scranton, Pa.---------
Syracuse, N. Y.-------
Trenton, N. J.--------
Utica, N. Y.----------
Yonkers, N. Y.--------

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.----------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.----------
Rockford, Ill.--------
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio------

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.----------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.-----------
St. Louis, Mo.--------
St. Paul, Minn.------
Wichita, Kans.--------


693
209
45
35
20
51
34
24
30
40
55
12
44
37
57

3,153
56
43
137
41
37
37
67
65
1,583
37
446
168
66
115
33
42
63
53
33
31

2,544
65
33
728
S146
227
132
92
326
36
57
38
26
49
149
33
136
33
34
46
98
60

808
56
24
38
138
16
90
69
238
69
70


410
108
22
25
13
30
21
19
17
25
30
7
28
25
40

1,812
30
25
75
24
16
26
40
27
913
25
263
88
38
68
21
24
39
29
24
17

1,403
32
18
383
90
120
71
57
191
19
26
17
13
25
89
12
81
20
21
21
58
39

484
31
17
21
91
13
56
43
136
38
38


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.----------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.-----------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ga.-----------
St. Petersburg, Fla.---
Tampa, Fla.-----------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.--------
Chattanooga, Tenn.-----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.---------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.----------
Fort Worth, Tex.-------
Houston, Tex.----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.----------
Glendale, Calif.-------
Honolulu, Hawaii------
Long Beach, Calif.----
Los Angeles, Calif.----
Oakland, Calif.------
Pasadena, Calif.-------
Portland, Oreg.--------
Sacramento, Calif.----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-----
Seattle, Wash.---------
Spokane, Wash.----------
Tacoma, Wash.-----------


1,122
135
242
39
73
88
51
99
32
72
68
175
48

628
79
57
34
147
126
46
38
101

1,077
51
62
32
153
43
86
160
52
163
67
94
48
66

447
42
32
138
15
102
17
55
46

1,571
28
43
27
47
85
467
116
36
126
52
97
179
46
137
48
37


Total 12,043 6,671 414 649

Cumulative Totals
including reported corrections for previous weeks


All Causes, All Ages -------------------------
All Causes, Age 65 and over-------------------
Pneumonia and Influenza, All Ages-------------
All Causes, Under 1 Year of Age---------------


496,876
286,186
20,048
23,525


Week No.
39







S368 Morbidity and Mo

-- RECOMMENDATION OF THE PUBLIC HEALTH SERVICE
ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES


A 2 IN LENZ A. RSr VACI NE MONO/ lar ALttE N 1 0 68 I -rn 6tindaliOli
A2 INFLUENZA VIRUS VACCINE, MONOVALENT, 1968-69


A2 INFLUENZA VIRUS VACCINE, MONOVALENT, 1968-69


rtalily Weekly Report


SEPTEMBER 28, 1968


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000. IS P ._Li-Fr- .- "rHE NATIONAL COMMUNICABLE
DISEASE CENTER, ATL -'. T : -
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
:*- .'. j :-Nic M.D
CHIEF. *C-"- lCl.. F- LRAM *'I T :'l M.D
CHIEF. IDA L. SHERMAN, MS.
EDITOR MICHAEL B GREGG, MO-

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
-,CT AND MORTALITY, THE N- 7-''. -;" *L. i-rlij. I CL SEASE
.r. -. ELCOMESACCOUNTSOF.r T' :r, ., k. -A a CASE
INVESTIGATIONS WHICH ARE OF CURRENT .rTr:: TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELA i'.i 'C iHE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30333
.: .f i, T AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO -E N-.:l. BY THE NIM, I',jL
STATE HEALTH ,' T -r rT5 THE E ,.'' TN,., WEEK CO'J. L 'JC-:
ONSATURDAYI C :t' L i : P rFAON NATIONAL BASiS ARE K i "r
ON THE SUCCEEDING FRIDAY


The Public Health Sern ice Advisory Committee on Im-
munization Practices recently\ recommended that adults and
children witl chronic debilitating diseases and all those in
older age groups be \accinated with the new monovalent
vaccine, A\. Aichi 2 i66 (Hong Kong Variant) when it be-
comes available I'.1' lIt Vol. 17, No. 35, Week Ending
August 31, 1968). It is to contain 400 Chick Cell Aggluti-
nating (CCA) unit pier dose.
\ii,. i, .i effectiveness of the new vaccine can be sub-
stantiated with certainty only by field use, a single dose
can be expected to afford significant protection, judging
from experience with comparably potent monovalent in-
fluenza vaccines. If field tests indicate that a booster dose
is necessary, further recommendation will be made.
Immunization should begin as soon as practicable after
the vaccine becomes available. It is important that the vac-
cine be administered before influenza occurs in the immedi-
ate geographic area because there is at least a 2-week in-
terval between vaccination and maximal ,ra,Il.,,.. response.

Vaccine Dose (Influenza Virus Vaccine, Monovalent)*
All injections should be given subcutaneously (the
intradermal route is not recommended for primary immuni-
zation).
Adults and Children Over 10 Years Old: 1.0 ml.
Children 6 to 10 Years Old: 0.5 ml.**
Children 3 Months to 6 Years Old: 0.1-0.2 ml. on two
occasions 1 to 2 weeks apart,.**

Contraindication
Since the vaccine viruses are propagated in eggs, the
vaccine should not be administered to anyone who is hy-
persensitive to eggs.


INFLUENZA CHEMOPROPHYLAXIS 1968-69

During the past few years, amantadine hydrochloride,
a virus chemoprophylactic, has been available. The drug is
reported to prevent or modify illness caused by some strains
of type A2 influenza virus if taken before exposure. Pre-
liminary laboratory tests by the manufacturer suggest that
the drug is active against the Hong Kong Variant of A2
influenza virus in eggs and might be applicable to preven-
tion of human disease.
In weighing the possible usefulness of amantadine
hydrochloride for influenza control in 1968-69, several
problems must be recognized: There has been no satis-
factory study of the drug's effectiveness in the general
population under conditions of natural exposure. Further-
more, in order to be protective, the drug must be administered
before exposure which, in practice, necessitates giving it
regularly during the entire period of possible influenza in-
fection. Finally, the drug's acknowledged side effects are
most common in older persons for whom protection is es-
pecially important.
In view of these limitations, therefore, amantadine
hydrochloride is not presently recommended as a public
health measure for community control of influenza nor as a
substitute for influenza vaccine immunoprophylaxis.
*The do e volumes indicate ed are bsed ton vac ine containinIg 400 CCA
unit, per 1,0 mi. Equivalent dose volume of highly purified mono-
valrIt vaccine may differ but is indicated by manufacturer.
-*Sln- febrile reatlions in this age group are common following in-
tlu tnza vaccination, an aRtilyrletl may be indicated.


M I
m V

o- -4


-4 o
= ) t z. )
-> > m m


m r
M "r = 0
m, In" C


M M
-4
0
1CZ


*: .F r ,"




U.S. 'T 3" R


U.S. '.POSi'OR v